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Abstract
ABSTRACT
Acute aortic dissection is the most frequent and lethal presentation of acute aortic syndromes with an incidence of 3-4 cases per 100.000 per year. In general, 20% of patients with aortic dissection die before reaching the hospital and 30% die during hospital admissions. We present two cases of acute aortic dissection we received in sequence over a period of one month: A case of Standford type A aortic dissection with extension to renal and iliac arteries initially misdiagnosed as acute myocardial infarction and a case of standford type B aortic dissection. A clinician may not attend to a case of aortic dissection in all his practice. High index of suspicion and initiation of appropriate registries are potential avenues to curb mortality.
RÉSUMÉ
La dissection aortique aiguë est la présentation la plus fréquente et la plus mortelle des syndromes aortiques aigus avec une incidence de 3-4 cas par 100.000 par an. En général, 20% des patients atteints de dissection aortique meurent avant d'atteindre l'hôpital et 30% meurent au cours des hospitalisations. Nous présentons deux cas de dissection aortique aiguë que nous avons reçus en séquence pendant un mois : un cas de dissection aortique de type A de Standford avec extension aux artères rénales et iliaques initialement mal diagnostiquée comme un infarctus aigu du myocarde et un cas de dissection aortique de type B. Un clinicien ne peut pas assister à un cas de dissection aortique dans toute sa pratique. Un indice élevé de suspicion et l'instauration de registres appropriés sont des moyens potentiels de limiter la mortalité.
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References
- Carpenter SW, Kodolitsch YV, Debus ES, Wipper S, Tsilimparis N, Larena-Avellaneda A, et al. Acute aortic syndromes: definition, prognosis and treatment options. J Cardiovasc Surg (Torino). 2014 Apr;55(2 Suppl 1):133–44.
- Criado FJ. Aortic Dissection: A 250-Year Perspective. Tex Heart Inst J. 2011;38(6):694.
- Karthikesalingam A, Holt PJE, Hinchliffe RJ, Thompson MM, Loftus IM. The diagnosis and management of aortic dissection. Vasc Endovascular Surg. 2010 Apr;44(3):165–9.
- Hagan PG, Nienaber CA, Isselbacher EM, et al. The international registry of acute aortic dissection (irad): New insights into an old disease. JAMA. 2000 Feb 16;283(7):897–903.
- Ince H, Nienaber CA. Diagnosis and management of patients with aortic dissection. Heart. 2007 Feb;93(2):266–70.
- Strayer RJ, Shearer PL, Hermann LK. Screening, Evaluation, and Early Management of Acute Aortic Dissection in the ED. Curr Cardiol Rev. 2012 May;8(2):152–7.
- Guilmet D, Bachet J, Goudot B, Dreyfus G, Martinelli GL. Aortic dissection: anatomic types and surgical approaches. J Cardiovasc Surg (Torino). 1993 Feb;34(1):23–32.
- Cohen R, Mena D, Carbajal-Mendoza R, Arole O, Mejia JO. A case report on asymptomatic ascending aortic dissection. Int J Angiol Off Publ Int Coll Angiol Inc. 2008;17(3):155–61.
- Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection*: A population-based longitudinal study over 27 years. Chest. 2000 May 1;117(5):1271–8.
- LeMaire SA, Russell L. Epidemiology of thoracic aortic dissection. Nat Rev Cardiol. 2011 Feb;8(2):103–13.
- Kurabayashi M, Miwa N, Ueshima D, Sugiyama K, Yoshimura K, Shimura T, et al. Factors leading to failure to diagnose acute aortic dissection in the emergency room. J Cardiol. 2011 Nov;58(3):287–93.
- Harris KM, Strauss CE, Eagle KA, Hirsch AT, Isselbacher EM, Tsai TT, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection: the International Registry of Acute Aortic Dissection (IRAD). Circulation. 2011 Nov 1;124(18):1911–8.
- Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A, et al. Predicting Death in Patients With Acute Type A Aortic Dissection. Circulation. 2002 Jan 15;105(2):200–6.
References
Carpenter SW, Kodolitsch YV, Debus ES, Wipper S, Tsilimparis N, Larena-Avellaneda A, et al. Acute aortic syndromes: definition, prognosis and treatment options. J Cardiovasc Surg (Torino). 2014 Apr;55(2 Suppl 1):133–44.
Criado FJ. Aortic Dissection: A 250-Year Perspective. Tex Heart Inst J. 2011;38(6):694.
Karthikesalingam A, Holt PJE, Hinchliffe RJ, Thompson MM, Loftus IM. The diagnosis and management of aortic dissection. Vasc Endovascular Surg. 2010 Apr;44(3):165–9.
Hagan PG, Nienaber CA, Isselbacher EM, et al. The international registry of acute aortic dissection (irad): New insights into an old disease. JAMA. 2000 Feb 16;283(7):897–903.
Ince H, Nienaber CA. Diagnosis and management of patients with aortic dissection. Heart. 2007 Feb;93(2):266–70.
Strayer RJ, Shearer PL, Hermann LK. Screening, Evaluation, and Early Management of Acute Aortic Dissection in the ED. Curr Cardiol Rev. 2012 May;8(2):152–7.
Guilmet D, Bachet J, Goudot B, Dreyfus G, Martinelli GL. Aortic dissection: anatomic types and surgical approaches. J Cardiovasc Surg (Torino). 1993 Feb;34(1):23–32.
Cohen R, Mena D, Carbajal-Mendoza R, Arole O, Mejia JO. A case report on asymptomatic ascending aortic dissection. Int J Angiol Off Publ Int Coll Angiol Inc. 2008;17(3):155–61.
Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection*: A population-based longitudinal study over 27 years. Chest. 2000 May 1;117(5):1271–8.
LeMaire SA, Russell L. Epidemiology of thoracic aortic dissection. Nat Rev Cardiol. 2011 Feb;8(2):103–13.
Kurabayashi M, Miwa N, Ueshima D, Sugiyama K, Yoshimura K, Shimura T, et al. Factors leading to failure to diagnose acute aortic dissection in the emergency room. J Cardiol. 2011 Nov;58(3):287–93.
Harris KM, Strauss CE, Eagle KA, Hirsch AT, Isselbacher EM, Tsai TT, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection: the International Registry of Acute Aortic Dissection (IRAD). Circulation. 2011 Nov 1;124(18):1911–8.
Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A, et al. Predicting Death in Patients With Acute Type A Aortic Dissection. Circulation. 2002 Jan 15;105(2):200–6.